Communication with families and critically ill
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Introduction
Critical illness is a lived experience that is sudden and often than not, affects the sufferer or the patient and the family. The condition of the patient throws the family of the patient into a crisis. The critically ill patients normally fall into a situation of total confusion whether at the beginning of their illness or after they have been treated, and they are emerging from a comma. The confusion that they have can be lasting or momentary. The confusion and the various stress levels normally affect the communication between the critically ill patients and their family members. This is because the situation of one’s family member being critically ill is not what happens regularly. The family members of the sick patient are sometimes overwhelmed by the encounters that they have in their experiences in the intensive care units. Critical illness normally occur without any form of warning and this also pushes the families of the patients beyond what is considered as normal realm of handling and leading to the experience of the trauma and the crisis within the family.
In the lives of human beings, psychological factors are significant facets of dying and living. These factors are the human responses to the challenges that the individuals confront in their daily lives. Additionally, psychological factors impact on the physiological challenge outcomes that the family members and the patients expect to have. A good example of the psychological factors includes self-esteem and self-efficacy, and these factors are related to the positive or negative outcomes of the health changes that the critically ill patients face. An assumption that has to be considered is that psychological factors of care are critical to improving the health and the quality of the patient's care at the end of life.
Stressors in a term that has been used to describe the events or the situations that have the capability of inducing or releasing the emotional stress that the family members or the critically ill patients have. Additionally, stress can be used to refer to the changes in the emotional feelings of certain individuals. Critical illness is a term that has been used to refer to a certain lived experience of a patient that is mostly considered severe. This condition normally affects the quality of life to the patient and the close family members. The medical accounts of the critical ill patients in some instances fail to recognize the vital impact that the patient has on the person in terms of their self-esteem and their ability to move on with their lives after the individuals leave the hospitals. It should be noted that critical illness is an acute life-threatening event and is mostly long lasting even after the patient has been discharged from the hospital. The survivors of a critical illness are normally left in a state of limbo that is characterized by the struggle to reclaim their precritical intensive care unit identity and the uncertainty about their future. Therefore, the state caused by a critical illness leaves the patient in the condition of imprisonment, being trapped and disruption.
Critical care, on the other hand, refers to the process of carefully handling of the patient in the intensive care unit(Albert et.al 2003, p.45). This process occurs as an interface between the patient, the nurse and the family members. This process requires compassion and humanism despite the aggressive technology that is available on the care of the patients. This process is also immensely influenced by the environment that the patient is in. the intensive care units were developed as a result of the need to have a specialized form of care to the patients.
Baum (1997, p.34) argue that in terms of the psychosomatic well-being of the individual, the concept can be defined as the process of seeking the sense of control in the face of the life-threatening illness that is mainly characterized by the altered priorities, emotional distress and the fears of the unknown. The positive life changes may also be considered. There are various queries that individuals offering the responsibility of psychological well-being of the individual may be asked. These questions may include what the patients worry about, what they can cope with and how the nurses attending to them can help them.
The stressors that influence the psychological well-being of the critically ill patients
There are various stressors that affect the psychological well-being of the critical ill patients and they include; further debilitation and dependency, lingering, uncertain futures, dying alone, changing relationships, loss of control, change in the mental functioning, pain and suffering, consequences for dependents and arranging affairs and the afterlife.
One of the main stressors of the critically ill patient is the uncertain future. This kind of uncertainty leaves the individual emotionally stressed in that the individual do not comprehend how their prospectS will turn out to be. Clochesy (1996, p. 56) argue that for some, the only certainty that they have is death while for others the notion of having to depend on other people for assistance is not good. When the patients think of these uncertainties, their health may be severely affected. The patients have to deal with the initial medication stress and then the uncertain future. It is up to the family members of the patients to ensure that their loved ones receive words of encouragement. The other stressor that affects the health of the patient is the change in the mental functioning of the individual. If a mental sane person is affected by the illness to the extent of dependence on other people for thinking, then the health of the sick person is affected. The mental condition of the patient may also influence the patient to self-hurt or self-mutilate. The psychological well-being of the individual is thus hurt.
Once a critically ill patient has decided that the illness that they are suffering from cannot be healed, and death is a certainty, the patient starts arranging for affairs after death. The patient may lose hope in life and the will to fight for life is lost. It is normally the strength and will power that sick patients have to fight for their lives.
Short and long-term impact of these stressors on psychological well-being of the critically ill patients
There is constantly a very thin line between the impact of the stressors on the physiological well-being of patients in terms of long and short terms. Emotionally, the critically ill patients may be impacted negatively on how they live their lives. In the cases of debilitation and dependency, the patients are in a position of increased stress. This kind of stressor can affect the health of the patient negatively. In some instance, the patient may go into a large extent of not having to feed properly as the stress of how their children or relatives who were depending on them fair on without their help. In the instance of the fear of death, the patients may be psychologically disturbed for a few times initially. However, when the certainty of death arises, the health of the patient may be harmed. Some patients even inform the medical practitioners to give them medications to end their lives if they are stressed to the limit. This normally occurs in the long term. In the short term, the change in the mental functioning of the patient is not that detrimental. However, in the long term, the critically ill patient may find it very difficult to comprehend the situation. In some cases, the long-suffering may require assistance in feeding. This does not only stress the patient but also the other members of the family. Additionally, this stressor can affect the patient negatively in that the patient may not be in a position to care for oneself once discharged from hospital. In equally the short and long term, the patients my suffer from the pain and suffering that has been caused by the illness. If the patient is given medications such as the use of painkillers, the painkillers may have other adverse medical implications such as an increase of nausea and dizziness.
The relationships between the patients and the other members of the society may be impacted also in both the long term and the short time. According to British psychological society (1993, p.23), In the short term, the family members may comprehend the loss of memory of their critically ill patient. This however is acceptable to some people in the short term. In the long term, if the sick individual does not recognize the members of his family, then both the patient and the family affiliates are influenced. For some of the patients, the need to have control over the happenings of life is a necessity. Once the patients realize that they do not have the control, their health is immensely affected. The patients may result to other forms of medications such as the use of inappropriate healing means. A case scenario is whereby an individual is severely ill of a kidney malfunction. The individual may resort towards purchasing the kidney from an individual who is willing to sell. In the medical world, this process is not acceptable due to the trade in human organs. The other impact that the stressors have is the emotional toll that the family members have to deal with. For some family members, they do not comprehend why their family member is in the situation that they are in.
Appraise the strategies that the nurses can use to enhance psychological well-being of patients in critical care
There are innumerable approaches that the nurses can use in order to enhance the psychological well-being of patients in critical care. The approaches can be adoptive and sometimes can be maladaptive. The difference between the maladaptive and the adaptive approaches can be viewed from the position or the perspective of the patient and whether the approaches mode allows the critically ill to achieve the objectives that they have set if they are in a position to set the goals. The strategies are normally implemented after the careful assessment of the patients in that the patients respond differently to the different psychological well-being of the patient.
One of the main strategies that the nurses have to deal with is the denial that the critically ill patients have. According to Kennedy-Moore (1999, p. 102), the denial process can be beneficial to the patient in the short term if the denial can enable the patient to sustain their integrity and personal information. When a patient decides to use denial as a way to cope with their psychological needs, it is up to the nurse caring for the patient to respect that decision. This is only helpful in the short term. This is due to the fact that the patient is not in a position to accept what has befallen him or her. This may lead to long-term repercussions in that the patient may be severely impacted by the choices that they make in the future. A patient may think that they have completely healed only to have setbacks and may lead to severe depressions. The patient may opt to other methods of self-fulfilment and may even consider suicide. It a long term, however, the negative aspect of promoting denial is that the denial that the patient has may affect the patient’s progress of getting well. The patient may thus be not capable of putting the personal feelings in order. In this instance, the nurse my consider asking the patients what would happen to them in case they do not fully recover from illness. The response that the nurse receives is used to redirect the patients thinking towards the positive thinking. The nurses should lead the patient towards changing the aspect of denial by discussing their options in the future and how they can be helpful.
The other strategy that nurses have to cope with is the fear and anxiety of the patients. Anxiety can be considered as a response to nothing specific while fear is a response to a certain perceived danger. In this strategy, the nurses have to explore the concerns of the patients in terms of what frightens them. In this strategy, the nurses have to comprehend what is essential to the treatment of the patient in terms of their concerns and fears. This method is effective when the care provider haves meetings with the family members of the patient including the physicians of the patient in order to reassure the patient of the fears and concerns that the patient is having. The other advantage of this approach is that most of the individuals who are pretentious by the illness of the patient are consulted, and the decisions that are made are uniform. The nurse cannot make verdicts for the patient. In this approach, what is mostly difficult to deal with is the perception that the patient thinks will happen to him in the case of severity of the illness. When the patient thinks of dying, the consultations that the nurse has with the other parties are helpful in assuring the patient of the future. The consultations can also be helpful in the choice of the area that the patient may want to continue the rehabilitation. Some individuals have preferences such as the completion of the treatment at home.
In order to deal with depression and withdrawal, the nurses have to make assessments of the patient’s condition. The clues that the nurse have on the diagnosis of the depression in the terminally ill patients can be identified. Once a nurse employs this strategy, the lack of pleasure, dysphoria, hopelessness, worthlessness, helplessness, social withdrawal can be identified early and other strategies to deal with the situation implemented. This means that the early identification of the problem can lead to the early intervention and thus minimizing the effects. Elliott et al. (2012, p. 15) notes that this strategy also reduces the need for the use of other screening procedures and resources that are used in case the patient’s illness is further compounded by the depression that the patient has. The family members of the patient can also be helpful in that the patients can receive encouragement from them and reduce the instance of depression.
While offering care, nurses have to be compassionate and understanding in terms of the anger and resentment that the patients have. The importance of this strategy is that the nurse comprehends the reasons why the patient is experiencing the causes of anger and can be able to find an effective solution. This thus demonstrates the respect that the nurse has for the patient and empathy. To some patients, this can be a source of comfort and consolation. If this strategy is not properly implemented by the nurses, then the patient can isolate himself precisely and loose the connections that the patients have with the other people. The anger that the patient has with other people can be escalated immensely if this strategy is not well taken care of.
Castellano (2003, p . 67) argues that in caring for the critically ill patients, it is vital that the nurses and the family members proceed under the lines of breaking down the complex issues that the patients have to deal with and allow great clarity of the subject matter. The process and purpose of the care that the critically ill patients are that it gives the patient a greater comprehension of oneself in their current situation. The major approach for the care of the patients by the nurses is the listening and the probing by the family members. When the family members and the nurses have a comprehension of the patient’s illness, the possibilities that are keeping the patients in their new situation can be explored.
In conclusion, the manner in which nurses communicate with patients is of high significance to the health of the patient. It is the responsibility of the family members and the nurses to ensure that the proper communication is given to a sick patient so as to increase their chances of living. There are various stressors that may impact the psychological well-being of the individual in that the impacts are severe if not well managed. These stressors include the loss of control, change in the mental functioning, pain and suffering, consequences for dependents and arranging affairs and the afterlife. There are also short and long-term impacts that the above stressors can have on the critically ill patients. The short term effects can be dealt with proper communication while the long term effects have to be dealt with by a psychological specialist.
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